December 15, 2004

Technology, Choice and Rights

The technology discussed in the story is not abortion because it is an extension of the in vitro fertilization process where the embryos are tested for genetic diseases, only here the "disease" is whether the child would have the wrong sex organs. As such, it connects with some of the same ethical questions as with sex-selective abortion.

Let's hear from a doctor promoting the technology:

"These are grown-up people expressing their reproductive choices. We
cherish that in the United States," said Jeffrey Steinberg, director of
the Fertility Institutes, which offers the service at clinics in Los
Angeles and Las Vegas. "These people are really happy when they get
what they want. These are heartwarming stories."

Dare we ask how the parents would react if their child was of the "wrong" sex? Oh, here's what happens:

"If you ask couples coming in what they will do if they get the wrong
sex, these couples say very frankly they will terminate the pregnancy,"
said Mark V. Sauer, director of the division of reproductive
endocrinology at Columbia University. "I don't want to be a party to
that."

At this point arguments for unfettered choice with regards to abortion confront the realities in India, China and some other places where female fetuses are systematically aborted at a higher rate than male fetuses.

Newsweek ran a story on this at the start of the year, but there is research on the topic going back more than a decade. Here is a paper published in 1994 in an edited volume by the Harvard School for Public Health. Raw figures on birth rates by sex do not tell the whole story, however. This paper released by Singapore's Ministry of Health shows in startlingly clear detail that in China and South Korea, the more children a family has, the less likely a girl will be born by a wide margin.

But using these data to make a pro-life case misses the point. It is the fact that girls and women have such low value for families that many there make the choice to abort female fetuses. The solution, in other words, is not to ban abortion. Without attacking the underlying cultural, social and economic causes leading to such attitudes, even if a ban stopped abortion (unlikely) in many cases girls would still have a higher risk of infanticide as well as poor health and early death due to maltreatment. The problem isn't abortion itself, but the cultural context in which the choice is provided.

Using in vitro fertilization to make sex choices in this country takes it out of the abortion debate (except for the most radically pro-life) but does not resolve these questions of value placed on boys and girls. Moreover, while in this country the selection may not obviously benefit one sex over the other, as the Post story claims (though I'd like to see more systematic evidence), it does not resolve potentially uncomfortable personal and social justifications why one gender would be favored over another in any given birth.

The arguments for the kind of choice contemplated here ring hollow to me. Perhaps there is a good argument for sex selection, but I haven't heard it. Here are the ones put forward in the article:

A family has had enough children of one sex and wants to have a child of the other sex

For parents to plan "the birth order of their children" -- huh?

Just because.

My concern isn't so much that down the road we'll turn into a Gattaca-like society. That level of genetic planning is, oh, two or three years away at least.

Perhaps it's because I have one brother and one sister without my parents really trying (as far as I know), but I just don't get why a parent would or should care, let alone spend the thousands of dollars in wish fulfillment.

Providing the capability to select "optimal" embryos, including sex, gives us the chance to satisfy our hubris. Such choices overestimate the extent to which genetic characteristics predict outcome, not just in underestimating the role of nurture over nature but also in the complex ways the two interact. (For that matter, wouldn't it be interesting if a family carefully selected the sex of their new baby, only to find out later that their child is transgendered? How exactly would they react? How should they react?)

What's the solution, ban the technology? I find the claim that there is a "right" to make sex selections as dubious as the justifications for doing so. At the same time, a ban doesn't seem practical since the same techniques are used to screen for serious genetic diseases. It would be difficult to enforce, if at all. At a minimum, however, it ought to mean genetic counseling for the parents, and some deep reflection as a society about sex, gender and our children.

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